ADJUSTMENT DISORDER

Summary

The Veteran served on active duty from January 2003 to October 2003. The Veteran appeals the denial of an initial compensable rating for adjustment disorder with depressed mood and the remand of a claim for service connection for a bilateral foot condition. Regarding the adjustment disorder, the Veteran contended entitlement to a compensable rating, citing the General Rating Formula for Mental Disorders. The Board reviewed the Veteran's post-service occupational history, which indicated successful business operations and positive employment evaluations, suggesting minimal occupational and social impairment. The VA examiner diagnosed adjustment disorder with depressed mood but concluded the symptoms were not severe enough to interfere with occupational and social functioning or require continuous medication. The Board found the VA examiner competent and credible, noting the Veteran's minimal work-related challenges and lack of significant social impairment attributed to the condition. The Board denied the claim for an initial compensable rating, finding a 0 percent rating warranted. For the bilateral foot condition, the Board remanded the claim for a new VA examination and opinion to determine the nature and etiology of the Veteran's foot disability, noting inconsistent service treatment records and the need for further clarification on the in-service event.

Rationale

Veteran's post-service occupational history indicates minimal impairment.; VA examiner found symptoms not severe enough to interfere with occupational/social functioning or require continuous medication.; Board found VA examiner competent and credible.

Full Decision Text

Citation Nr: A26039044
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 250711-564387
DATE: April 27, 2026

ORDER

An initial compensable rating for adjustment disorder with depressed mood is denied.

REMANDED

Entitlement to service connection for a bilateral foot condition is remanded.

FINDING OF FACT

The competent and probative evidence of record weighs persuasively against a finding that the Veteran's adjustment disorder with depressed mood interferes with her occupational and social functioning or requires continuous medication.  

CONCLUSION OF LAW

The criteria for an initial compensable rating for adjustment disorder with depressed mood are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.130, Diagnostic Code (DC) 9440.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from January 2003 to October 2003. 

This matter is before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in August and December 2024 by a Department of Veterans Affairs (VA) Regional Office (RO). 

In her July 11, 2025 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Based upon the selection of the Direct Review option, regarding the claim for service connection for a bilateral foot condition, the Board may only consider the evidence of record as of August 5, 2024-the date of the rating decision on appeal. See 38 C.F.R. § 20.301. If the Veteran submitted evidence that was added to the record after August 5, 2024, the Board did not consider it. However, because the Board is remanding the claim for service connection for a bilateral foot condition, any evidence not considered by the RO will be considered in its readjudication. 38 C.F.R. § 3.103(c)(2)(ii).

Regarding the claim for an increased rating for adjustment disorder, based upon the selection of the Direct Review option, the Board may only consider the evidence of record as of December 10, 2024-the date of the rating decision on appeal. See 38 C.F.R. § 20.301. If the Veteran submitted evidence that was added to the record after December 10, 2024, the Board did not consider it. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence. See 38 C.F.R. § 3.2501.

The Board notes that the Veteran marked a box on the VA Form 10182 and made a written request for an extension on her July 11, 2025 notice of disagreement. See 7/11/2025 VA Form 10182. However, all of the issues identified in the notice of disagreement have been timely appealed to the Board and, therefore, the Board finds no need to rule on this request and will proceed to the merits on all identified issues. 

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Increased Rating

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentages are based on the average impairment of earning capacity as a result of service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007).

The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one disability is not duplicative of or overlapping with the symptomatology of the other. Esteban v. Brown, 6 Vet.
 compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007).

The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one disability is not duplicative of or overlapping with the symptomatology of the other. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14.

In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the U.S. Court of Appeals for Veterans Claims (CAVC) has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

An initial compensable rating for adjustment disorder with depressed mood.

The Veteran contends that she is entitled to an initial compensable rating for her service-connected adjustment disorder with depressed mood. 7/11/2025 VA Form 10182; see 9/23/2025 Appellate Brief. 

The Veteran's adjustment disorder with depressed mood is rated under DC 9440 under the General Rating Formula for Mental Disorders (General Formula). 38 C.F.R. § 4.130. Under the General Formula, the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

Under the General Formula, in pertinent part, a 0 percent rating is assigned for a mental condition that has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. 

A 10 percent rating is assigned for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.

A 30 percent rating is assigned occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).

A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

A 70 percent rating is assigned when symptoms such as suicidal ideation;
 depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).

A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name.

The Veteran underwent a VA examination in August 2024. 8/28/2024 C&P Exam. The VA examiner conducted an in-person interview with the Veteran and indicated their review of the Veteran's electronic health record and VA e-folder. Id. at 1, 3. The examiner rendered a diagnosis of adjustment disorder with depressed mood. Id. at 2. The Veteran provided a detailed history of her post-service occupational history, indicating that she started and successfully operated multiple businesses after her discharge from active service, including a hair salon, a game room, and a used car dealership. Id. at 4. She indicated that she had minimal work-related challenges and that she "conquered almost everything." Id. She described having an easy-going personality and reported that she always got along with her coworkers and supervisors. Id. Moreover, she described that her performance evaluations were always positive and that she never had problems or was fired and received promotions at various points. Id. As to social impairment, the Veteran described herself as always having been an introvert since the time she was a child. Id. She indicated that she lives alone, has never married, and has no children. Id. She indicated that she has always maintained a positive outlook but has noticed changes in her mood since about 2023 as she has reflected more on her life. Id. at 5. 

At the examination, the examiner noted the Veteran to be friendly, cooperative, alert, and oriented. Id. at 6. The Veteran's immediate memory was good, and her delayed memory was fair. She demonstrated appropriate speech rate, volume, prosody, and fluency. Id. The examiner described her affect as tearful and her mood as depressed, with good abstract thinking, judgment, and insight. Id. Her thought content was clear and logical and there was no evidence of delusions, hallucinations, or suicidal ideation. Id. The examiner concluded that the Veteran's symptoms warranted a formal diagnosis of adjustment disorder with depressed mood, but that her symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. Id. at 2. The Board finds the August 2024 VA examiner to be competent and credible and that the examination report carries substantial probative weight. 

The Board notes a November 2024 addendum to the August 2024 VA examination report in which the examiner clarified that the Veteran has mild adjustment disorder and minimal depression without any clinically significant impairment. See 11/14/2024 C&P Exam. 

The Veteran's VA treatment records indicate few mental health treatment references in the years preceding her claim. In February 2022, the Veteran denied past diagnoses or current symptoms of depression, anxiety, or mood disorders. 11/4/2024 CAPRI, p. 300. In February 2023, the Veteran reported feeling down, depressed, or hopeless several days, no difficulty concentrating on activities, little interest or pleasure in doing things more than half of the days, and no suicidal ideation. Id. at 156. Assessment results in 2023 were not sufficient alone for diagnostic purposes. Id. at 157. In April 202
 any clinically significant impairment. See 11/14/2024 C&P Exam. 

The Veteran's VA treatment records indicate few mental health treatment references in the years preceding her claim. In February 2022, the Veteran denied past diagnoses or current symptoms of depression, anxiety, or mood disorders. 11/4/2024 CAPRI, p. 300. In February 2023, the Veteran reported feeling down, depressed, or hopeless several days, no difficulty concentrating on activities, little interest or pleasure in doing things more than half of the days, and no suicidal ideation. Id. at 156. Assessment results in 2023 were not sufficient alone for diagnostic purposes. Id. at 157. In April 2024, the Veteran responded to a questionnaire indicating that that her interest or pleasure in doing things was normal, she did not feel down, depressed, or hopeless, she did not have low energy, and no trouble concentrating. Id. at 71. However, she did indicate having a poor appetite several days and having trouble sleeping. Id. In October 2024, the Veteran indicated that her mood comes and goes and she has experienced increased depression with "bad days" approximately once a month with improvement by better nutrition. Id. at 18. Furthermore, she reported alternating good and bad sleep with improvement from exercise and no suicidal ideation. Id. 

After review of the complete record, the Board finds that the Veteran's adjustment disorder with depressed mood does not interfere with her occupational and social functioning and does not require the use of continuous medication. The Veteran's VA treatment records do not indicate that she has been prescribed medication to treat her symptoms. Moreover, when considered holistically, the record tends to show that her symptoms result in a minimal impact on her occupational and social functioning, with no specific reports of any disturbances. The Veteran's August 2024 VA examination supports that the Veteran had a successful post-service career operating her own businesses and serving as a productive employee while working for others. Furthermore, the Veteran self-reported minimal work-related challenges. Although the Veteran detailed some regrets regarding her personal life, she did not attribute any social difficulty to her mental health condition but, rather, described herself as an introvert. Therefore, based on the Veteran's VA treatment notes and August 2024 VA examination, the Board finds that a noncompensable (0 percent) rating is warranted for the Veteran's mental health condition. 

The Board has considered whether the next-higher rating of 10 percent is warranted by the record. The record does not support that the Veteran's current symptomatology results in any decrease in work efficiency or inability to perform occupational tasks during periods of significant stress. The Veteran consistently reported no difficulty in her ability to concentrate on activities and, as of October 2024, indicated that she experiences depression only approximately one time per month that is improved with better nutrition. Moreover, the record indicates that the Veteran has not utilized continuous medication for treatment of her symptoms. Therefore, the Board finds that a higher rating of 10 percent is not warranted by the record.

While the Board acknowledges and is grateful for the Veteran's honorable service, the Board finds that the competent and probative evidence of record weighs persuasively against the claim and that an initial compensable rating is not warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Accordingly, the Veteran's claim for an initial compensable rating for adjustment disorder with depressed mood is denied. 

REASONS FOR REMAND

Service connection for a bilateral foot condition is remanded.

The Veteran contends that she is entitled to service connection for a bilateral foot condition. 7/11/2025 VA Form 10182. Of note, the August 2024 rating decision on appeal found that new and relevant evidence had been presented and readjudicated this matter on the merits. The Board sees no reason to disturb this favorable finding and will now address the merits too. 

The Veteran has not been afforded a VA examination in relation to her claim. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, four factors are for consideration: (1) competent evidence of a current disability or recurrent symptoms; (2) establishment of an in-service event, injury, or disease; (3) indication that the current disability may be associated with an in-service event; and (4) insufficient competent medical evidence to decide the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-85 (2006).

Here, the medical evidence of record indicates that the Veteran has at various times had diagnoses of multiple foot conditions, including bilateral pes planus and bilateral plantar calcaneal spurs. 8/8/2022
 VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, four factors are for consideration: (1) competent evidence of a current disability or recurrent symptoms; (2) establishment of an in-service event, injury, or disease; (3) indication that the current disability may be associated with an in-service event; and (4) insufficient competent medical evidence to decide the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-85 (2006).

Here, the medical evidence of record indicates that the Veteran has at various times had diagnoses of multiple foot conditions, including bilateral pes planus and bilateral plantar calcaneal spurs. 8/8/2022 CAPRI, p. 138; 8/1/2024 CAPRI, p. 21. The Veteran's service treatment records (STRs) contain inconsistent notes regarding her feet. Records from the time prior to active duty indicate no foot trouble or impairment. 9/20/2016 STR, p. 1. Despite a Report of Medical Examination from around the time of her entry onto active duty indicating mild, asymptomatic pes planus, a later Report of Medical Examination from February 2004 indicated normal arches. 9/26/2002 VA Examination, p. 1; 4/12/2004 STR, p. 34. The Veteran has reported that she believes her foot issues were caused or aggravated by service and that she utilized orthotics at her own direction in order to treat her symptoms. See 8/7/2012 Correspondence. It is unclear if the Veteran had a clinical examination upon entrance to her active duty service beginning in January 2003 as the dates on some of the examinations are conflicting. The record shows that the Veteran has been granted service connection for a total abdominal hysterectomy with right salpingo-oophorectomy based on her active service in 2003. 

Based on the foregoing evidence, and because there is otherwise insufficient evidence upon which a decision may be based, the Board finds the McLendon criteria were met prior to the rating decision on appeal and a pre-decisional duty to assist error was committed and a remand is required for correction. 38 C.F.R. § 20.802(a). As such, a medical examination and opinion must be obtained prior to adjudication.

This matter is REMANDED for the following action:

Schedule an examination and obtain an opinion from a VA professional with appropriate expertise to determine the nature and etiology of the Veteran's claimed foot disability/disabilities.

After review of the claims file and examination of the Veteran, the examiner is to specifically address:

(a.) Is it as least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any diagnosed foot condition is related to an in-service injury, event, or disease?

A comprehensive rationale for all opinions is to be provided and must not be based on the lack of an in-service record of the claimed disability. All pertinent evidence, including both lay and medical evidence, should be considered.

If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training).

 

 

Paul Sorisio

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Donahue, Thomas P.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.